An advisory protocol for treatment of acute complicated and uncomplicated spinal cord injury in adults (association of neurosurgeons of the Russian Federation). Part 3

Assessments and interventions on body functions, structures and activity to prepare adults with acute spinal cord injury or disease for participation: a scoping review

Introduction

In the acute phase after a spinal cord injury or disease (SCI/D), various therapeutic assessments and interventions are applied with the goal of restoring structures, preventing complications and preparing the patient as best as possible for further activity and finally participation. The goal was to identify and evaluate the available evidence on assessments and interventions for body functions and structures to prepare adults with acute spinal cord SCI/D for activity and participation during the first 14 days.

Methods

A scoping review was conducted. The search was performed on June 19, 2023 using the databases PubMed, PEDro, Cochrane library and Embase. These were screened for studies including patients with acute SCI/D and physiotherapeutic or occupational therapy assessments and interventions. Only studies in English or German published between 2012 and 2023 were included.

Results

Twelve publications met the inclusion criteria, namely three systematic reviews, two randomized controlled trials, two observational studies and five clinical practice guidelines. Assessments as the Spinal Cord Independence Measure, as well as exercises such as daily passive mobilization of body structures against contractures were used in the entire population, while others were only applied in subgroups of SCI/D such as the Graded Redefined Assessment of Strength, Sensation and Prehension or functional electrical stimulation with and without additional movements. The methodological quality of the studies found varied greatly from good to very poor.

Discussion

Heterogeneity in research design and study population as well as lack of high-quality studies do not cover the standard of clinical management in the acute phase and further comprehensive research is needed.

Rehabilitation of spinal patients with diseases and injury of the cervical spine in the early and late postoperative period (analysis of russian and foreign recommendations)

Despite the success of modern conservative therapy of severe spinal instability, surgical methods still retain their importance in the treatment of this pathology, but even the most successful operation may be in vain without subsequent adequate rehabilitation. This report summarizes the features of rehabilitation of patients after surgery for injuries of the cervical spine using methods and means of physiofunctional treatment.

Evaluation of the Effectiveness of Systemic Therapy of Spinal Cord Injury of Moderate Severity with Human Umbilical Cord Placental Blood Mononuclear Cells Using Indicators of Dispersion of Articular Angles in the Swimming Test

Female Sprague-Dawley rats were used as models of moderate contusion spinal cord injury to evaluate the efficiency of single systemic (intravenous) infusion of human mononuclear cord blood cells for restoration of the motor function of hind limbs. The dynamics of recovery of hind limb motor function was assessed using a specially designed method based on calculation of selective dispersion and amplitude-dependent dispersion of hind limbs joint angles measured in the swimming test. The obtained data suggest that systemic application of human mononuclear cord blood cells significantly (p<0.05) promoted recovery of hind limb motor function in the animal models of contusion spinal cord injury of moderate severity in comparison with control animals (without cell therapy).

[Endoscopic treatment of mine-explosive spine injuries: 3 clinical cases and literature review]

Modern warfare is characterized by common mine-explosive injuries. The last ones are accompanied by multiple injuries, large area of damage and severe clinical status of victims.

OBJECTIVE

To demonstrate treatment of mine-explosive spinal injuries using modern minimally invasive endoscopic techniques.

MATERIAL AND METHODS

The authors present 3 victims with various mine-explosive injuries. Endoscopic removal of fragments from the lumbar and cervical spine was successful in all cases.

DISCUSSION

Most of victims with injuries of the spine and spinal cord do not require urgent surgery and can underwent surgical treatment after clinical stabilization. At the same time, minimally invasive techniques provide surgical treatment with minimal risk and earlier rehabilitation, as well as reduce the risk of infectious complications associated with foreign bodies.

CONCLUSION

Careful selection of patients for spinal video endoscopy will ensure positive outcomes. Minimization of iatrogenic postoperative injuries is especially important in patients with combined trauma. However, well-experienced surgeons should perform these procedures at the stage of specialized medical care.

[Role of the RUANS recommendation protocol for decision-making in patients with acute traumatic cervical spine injuries]

Since 2013, neurosurgeons have been guided by the RUANS recommendation protocol for surgical management of patients with acute cervical spine fractures in Russia. However, there are no studies devoted to interobserver agreement between specialists with different experience.

OBJECTIVE

To evaluate the role of the RUANS recommendation protocol for decision-making in patients with acute traumatic cervical spine injuries.

MATERIAL AND METHODS

Twenty-one neurosurgeons from 5 hospitals estimated data of 64 patients with cervical spine fractures. The study implied choosing an option for patient treatment (conservative therapy; anterior, posterior and circular fusion surgery). Two evaluations of CT and MR scans with an interval of 1.5 months were conducted. In the main group (9/21), neurosurgeons strictly followed the RUANS recommendation protocol during re-evaluation. In the control group (12/21), neurosurgeons analysed data considering their own knowledge and experience. Interobserver agreement was evaluated using a Fleiss' or Cohen's Kappa (K).

RESULTS

Among the junior neurosurgeons (up to 5 years of experience), change in consent level during re-evaluation was greater in the main group (∆K=0.25) compared to the control group (∆K= -0.17). Among neurosurgeons with medium level of experience (5-10 years), ∆K was 0.19 in the main group and -0.15 in the control group. Among experienced neurosurgeons (over 10 years of experience), the main group showed an increase in Kappa (∆K=0.24), while level of consent remained almost the same in the control group (∆K=0.05).

CONCLUSION

The RUANS recommendation protocol can significantly improve interobserver agreement between specialists with various levels of experience regarding management of acute cervical spine injury.

Comparison of the Efficiency of Systemic and Local Cell Therapy with Human Umbilical Cord Blood Mononuclear Cells in Rats with Severe Spinal Cord Injury

Rat model of severe contusion spinal cord injury was used to study the effect of single intravenous and intraspinal injection of human umbilical cord blood mononuclear cells on the restoration of motor function of the hind limbs. Recovery of the motor function of the hind limbs was assessed using load tests and open-field test according to BBB scale. Cell injection via both routes significantly improved (p≤0.05) the recovery of the motor function of the hind limbs by 35-40% relative to the level of "self-recovery"; the effects of intravenous andintraspinal administration did not differ significantly.